Karyn Alayne Ledbetter MD, Presenter: Nothing to Disclose

Michael Eric Stone MD, Abstract Co-Author: Nothing to Disclose

Sheena Saleem MD, MBBS, Abstract Co-Author: Nothing to Disclose

Deniz Altinok MD, Abstract Co-Author: Nothing to Disclose

Although magnetic resonance imaging is routinely utilized in cases of suspected non accidental head trauma, little data exists regarding the use of imaging to evaluate for associated cervical spinal ligamentous injury. Furthermore, the association between ligamentous cervical injury and intracranial abnormalities on MRI has not been documented. Through retrospective review of MRI brain examinations, we aim to establish the value of fast spin-echo inversion-recovery (FSE-IR) in assessing for cervical spinal ligamentous injury in cases of suspected abusive head trauma.

MRI brain examinations performed in all cases of suspected non accidental head trauma between 2010 and 2013 were retrospectively reviewed. First, the fast spin-echo inversion-recovery (FSE-IR) sequence was examinated on each study to evaluate for hyperintense signal in the apical, anterior longitudinal, posterior longitudinal and interspinous ligaments. Subsequently, each positive study was evaluated for abnormal signal intensity on diffusion-weighted imaging, susceptibility-weighted imaging and on T2*.

A total of 60 patients with non accidental head trauma received MRI brain examinations in our institution between January 2010 and December 2013. Of these patients, 17 (29%) were found to have ligamentous injury on FSE-IR. Additional findings of severe trauma were also present on other MR sequences in all patients. Hypoxic ischemic injury, detected on diffusion-weighted imaging, was present in 10 patients (59%). Retinal hemorrhages, seen on the T2* sequence, were identified in 8 patients (47%) with concomitant ligamentous injury. Cortical venous thrombosis, detected on either susceptibility-weighted imaging or T2*, was present in 16 patients (94%).

The fast spin-echo inversion-recovery (FSE- IR) sequence detects cervical ligamentous injury in patients with non accidental head trauma and is associated with significant intracranial injuries including hypoxic-ischemic injury, thrombosed cortical veins and retinal hemorrhages. FSE-IR should be performed routinely in all cases of suspected abusive head trauma.

Fast spin-echo inversion-recovery detects ligamentous cervical spinal injury and should be routinely used whenever non accidental trauma is suspected.

Ledbetter, K, Stone, M, Saleem, S, Altinok, D, Fast Spin-Echo Inversion-Recovery (FSE-IR) Detects Cervical Ligamentous Injury in Non Accidental Trauma.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014342.html